How my treatment was planned, the results it has achieved and how it has affected me and my confidence
Author: Andrew – Company Director
A short diary of my personal journey to eradicating the demons of eczema and steroid cream usage over many years. This little diary has been written in order to document my journey as I remove something that I know now, has been damaging me, almost since birth. I am 56 years old now and have suffered with eczema since birth. Over the years, this has reduced significantly, however, my face and upper body is always prone to flare ups, especially after shaving. I have since found, this is almost certainly linked to my use of steroid cream throughout my life. Looking at some of the research into this, called Topical Steroid Addiction, it is apparent, that the journey to removing this harmful cream from my body, may not be an easy one, but one which must be done. Here is my first two weeks on this journey.
Thursday 29th April
Today was the last time I used the steroid cream I had used since I was a very young lad. I remember being smeared in it to within an inch of my life everytime I had a bath. Going to bed all slippery from it in my PJs. In the intervening years, as my eczema got better, I only really needed to ease my skin on my face, and after shaving. It was something I did that provided almost instant relief from the ravages of shaving. Shaving, just dried out my face, and skin care was not something I’d even considered as a man, not even moisturiser. I had, over the years got a hint of what damage the steroid cream was doing to me. If I had run out of the ointment, within 2 days, my face would go red, become very angry, and then more recently, the bags under my eyes would appear, and then swell. But, never fear, steroid cream would come to my rescue, and within a day or so, all would be good with the world again.
I knew nothing of topical steroid addiction. I just put the angriness and swelling down to not getting the treatment I thought I needed. A while back, I was advised that using steroid creams on my skin would have serious, and very bad outcomes for my skin, and that I needed to stop using it altogether. I remember the anguish I go through every time I miss a “dose”, and this filled my head with dread. Come on, what damage could it do I asked myself on more than one occasion. I had obviously dismissed the fine veins that had been with me since a very young age, and that as I got older, looked like I was an alcoholic. I had also dismissed the times, when I had banged my head or face on a not fully open car boot, or cupboard door, and my skin would peel open, like a tearing a bit of paper up. No, this was just me, and how I was? Thursday 29th April, was the day I was determined to start the journey to weaning myself off of steroid treatments. I was scared, worried about what would happen, and worried about what was next.
Friday 30th April
I consulted Chrystal at Le Sands Clinic and did another skin analysis. My skin was way out of balance, and was seriously dehydrated. I was recommended that I undertake LED light treatment, plus a morning and evening regime of Skeyndor AquaTherm, a treatment designed to take heat out of the skin, cool, and moisturise. It sounded fantastic. I was worried that dehydrated skin was result, and that this option would help overcome this. I felt great afterwards, and determined to see this through, and finally wean myself off of the nasty treatments I had used for the past 50 odd years. The other benefit was how relaxing the LED treatment and facial actually was.. wow!
Saturday 1st May
No reaction as yet.. woo hoo! My skin felt great. It was smooth, very relaxed, and not at all as I had feared. My morning and evening treatments are actually being kept up, and I am remembering to do them… that’s a major bonus!
Sunday 2nd May
Still feeling good. Maybe, just maybe, I may have dodged a bullet with coming off of the steroid cream. Am taking anti histamines too just in case. Morning and evening routines are progressing well
Monday 3rd May
It is now 4 days since I last used that nasty stuff. Am feeling pretty OK, although am having a few hot flushes but nothing really to worry about. I may just have beaten this!
Wednesday 5th May
Oh crap. I’ve woken up and my forehead and eyes are really, really dry, and a bit stingy. I hope this isn’t a reaction. As the day goes on, I feel my eyes start to swell up and those bloody bags are getting big again. Surely, after 5 days, I shouldn’t get a reaction like this. The day progresses, and I feel very hot, and my skin is really angry. I feel my eyes close up a little from the swelling. This is not good. Head back to Le Sands Clinic, and undergo another LED light session, plus hydration to try to ease things. That really helps, but I head home with very red head, and looking like I’ve been hit in both eyes. Not what I’d envisaged. There must be more to this than meets the eye. Surely, I can’t be the only one in the world to suffer like this when withdrawing my steroid cream? Can I?
Thursday 6th May
Woke up. Eyes swollen even more. Face very angry and red. I look like a red version of Shrek. My face is not itchy though which is really weird. Just hot, just angry, just swollen. I get to the office, then things ramp up a notch or 100. If I thought I looked like a red Shrek this morning, I look 10 times worse this afternoon. More LED treatments, more facial products. I feel like a freak. I cannot look anyone in the eye. The hit to my confidence is enormous. I feel so self conscious, and this is made worse when having to go to Coles. Everyone is staring at me. They are probably repulsed. They probably think they will catch whatever I have. They are probably glad they are not me. I put my head down as I walk through the aisles, not making eye contact with anyone for fear of scaring them. This is the low point so far. I need to get back on my steroid cream, surely, that will take this away and bring back the old me. The confident me. The perfectly imperfect me. The amiable and friendly me, not the grumpy person who has had every bit of confidence oozing out by the second. This even affects my work. I re read emails I have sent, and they are devoid of personality, devoid of warmth, devoid of humour. How the hell can a Shrek face affect the way you write..? I end the day, really down, really grumpy. We research what the hell this can be. Ah ha.. there is a known condition that affects people in exactly the same way as me. It is called Topical Steroid Withdrawal. Steroid creams, we read, can do enormous damage to the skin, and in effect, suppress the skin’s immune system. Prolonged usage of it, will mean, on withdrawal of the cream, the skin has no protections to it. The skin’s balance of oils is shot to pieces, and often, hydration is also reduced as the skin’s oils run amok. The only really long term treatment is withdrawal. This can take any between a few weeks, and months and months. Not what I wanted to hear. The recommended treatments are exactly as we had been doing, and the wonderful team at Le Sands Clinic had advised.
Friday 7th May
Woke up, my eyes hardly opening through the swelling. That set me off again on a downward spiral. Routines were done, and that seemed to provide a little relief. The redness has gone down my face now. My eyes look as if they had been hit by a hammer. Who knows where this will end up.
Saturday 8th May
No improvement, and now my angry skin is getting angrier lower down on my next. This is still really affecting my confidence, and I find it difficult to look anyone in the eye. I am not sure how much I can stand of this, or for how much longer. I am tempted to go back to my steroid cream, to give me some relief, but no, it is that which has done this damage all of these years. It would be like an alcoholic having just one drink to ease the pain. No, I must remain strong, despite this obviously affecting me, my work, my social relationships. Another Omnilux LED Light therapy session, and this brings a little immediate relief. Today I also started a course of oral cortisone steroids, the research into this condition indicates that a short, and reducing course of steroids are not likely to keep my skin hooked on them. So long as the course is short, and reduces after a week. Dr Saliba prescribes the course, and I start on them. Keeping fingers crossed.
Sunday 9th May
Day 2 of the additional steroids and no real improvement as yet. In fact, my neck is getting worse. The angriness in my skin is spreading lower down my neck. When will this end?
Monday 10th May
Oh my word, my face feels a little less tight, and definitely not as angry this morning. I am religiously keeping up with my home care skin routine; morning and night. I am even managing to shave now. My neck is in a bad way, but, as the days pass, I am confident this will ease now. The downside to today, is that my skin is getting really flaky. Gross! I have read and been told that this is really a good sign, and a sign that my skin is starting to recover. This will not be a pleasant phase of my recovery.
Tuesday 11th May
Wow, my face has cleared. The Puffiness in my eyes has gone, but they are incredibly dry and look like an elephant’s eyes. They look bloody awful. I double and treble down on my Skeyndor Aqua Therm moisturising cream. In fact, I moisturise every hour or so. It is weird, every time I do this, within 10 minutes, the skin around my eyes and upper cheeks just sucks the cream in and my skin feels like glass paper again. It is relentless, but shows how much damage has been done over the years. Keep going…
Wednesday 12th May
Really great improvement today, and my neck is starting to ease. I almost look normal and not like a red Shrek any more. I can feel my inner confidence coming back. The dryness in my skin is not quite so bad now, and I no longer have to use my Aqua Therm every hour! I drive back to Le Sands Clinic and have another Omnilux LED light therapy. This, apparently, helps to repair the deepest layers of my skin, and will be critical in me helping completely remove steroid cream from my life. The idea is that once my skin’s natural barriers are built up, I will retain hydration better, and also be able to withstand times of dryness.
Thursday 13th May
Woo Hoo – I am now almost completely rash free on my face and my neck. One massive thing I’ve noticed too, is my wrinkles around my eyes are now barely noticeable. That is one thing I didn’t expect to find. In fact, my skin looks fuller, and healthier. My big worry, is that this is only down to the oral steroids I am still on. The critical time, will be tomorrow when I start halving my dose for a few days, then halve again so that I am free of them by next week. This will be a real test I fear. On the plus side, there are some very visible signs that my skin is healthier, and who knows, maybe better placed to withstand real life. So far so good.
Friday 14th May
I will complete my journey now on my own, and continue with the treatment plan that Chrystal and Dr Saliba has given me. I also up my treatment today, with LED light Therapy, a deep moisturising facial, and even getting rid of any dead skin I have shed as part of this with an exfoliation. My confidence levels are back to normal, and I feel human again. These past 2 weeks have been difficult. I won’t candy coat this, really difficult, however, I can feel a completely new future coming on, and one where I am not dependent upon steroid cream. Thank you for listening to my current journey, This is the start My Next Phase, a phase in which I do not suffer issues with being able to look people in the eye, can stand proud and tall, and not have to bloody well scratch my face, or look like red Shrek again.
Brendan Rogers: Hello, everybody. I’m Brendan Rogers, the host of The Culture of Things podcast. This is Episode 30. If you didn’t already know, October is Breast Cancer Awareness Month. With this in mind, there’s nobody better to have on today’s episode than one of the leading breast cancer surgeons in Australia, Dr. Lucia Saliba. Luci, as she prefers to be called, is trained and accredited in Australia as a General Surgeon with a broad expertise in breast and general surgery including breast reconstruction. She graduated from the University of New South Wales in 1995 and went on to complete her General Surgery Fellowship in 2003. In 2005, Luci completed her Breast and Endocrine Fellowship with the Royal Australasian College of Surgeons. She’s trained extensively, both locally and overseas, in areas related to Breast Reconstruction, Breast Oncoplastics, and Breast Cancer Therapy. She’s also recently completed her Master of Surgery in Breast Cancer. Luci has a passion for education, teaching and supervising junior medical staff and surgical registrars in the fields of Breast and General Surgery. Luci is committed to excellence in surgery and providing holistic and compassionate care to patients in a timely fashion, endeavouring to ensure minimal wait times. She provides end-to-end care for patients, meaning a patient is able to stay with her from oncological surgery through to reconstruction. Many other surgeons do not offer the ‘before and after’ of looking after a patient. The focus of our conversation is gaining a perspective on culture, leadership and teamwork as a surgeon.
Brendan Rogers: It’s an absolute pleasure, Luci. I want to ask you a question. We’re going to dive straight in, but the most important question I need to ask you is, why in medicine do we use such big words that I find difficult to understand?
Lucia Saliba: (Laughing) We do that so that you think we’re very, very smart and really clever. Well, really, the truth is that medicine, like anything else, any other profession, has its language. And we use our language to be able to communicate with each other, so other medical practitioners. And because we all speak the same language, we can pretty much understand each other from all over the world. As people in any profession will know, being able to communicate is very important. And in our profession, it’s super important because it can impact somebody’s life if there is miscommunication. So it is really just a way for us to communicate clearly and without sort of ambiguity between each other. When it comes down to communicating with patients though, doctors have to become skilled in speaking in plain terms so that everyone can understand. For me, that’s been not too difficult a proposition because I come from a non-English speaking background and a non-medical family. So I’m very often having to explain what I do in very plain terms. So, yeah. That’s why we speak in big words.
Brendan Rogers: Thank you very much for that explanation. Luci, from what you shared with me before, when you were about three years old, you wanted to be in medicine. Do you remember back that far and sort of, what was it that gave you this inquisitive nature and the curiosity about wanting to be in this profession?
Lucia Saliba: I’m not sure, but I did tell my Mum at about the age of three or four that I was going to become a doctor one day and I got quite upset with her because she had bought my brother one of those doctor’s toy kits and she hadn’t bought me one. So I told her that, you know, “This was a waste of time because I was actually going to become a doctor when I grew up”. I have no idea where it came from. We have no doctors in the family. We had a very nice GP, but apart from that, there was really no other influence. And during my childhood and teenage years, I was glued to the TV watching MASH or any medical show that came on with extreme fascination. So I think that’s pretty much where it started from.
Brendan Rogers: You mentioned MASH, a famous show. So you now get to wear the white coat.
Lucia Saliba: (Laughing) We don’t have the white coats anymore, but we wear our theatre gear and gowns over the top and our hats and shoe covers. And yeah, so we have a different uniform, which is all about keeping clean and avoiding infection.
Brendan Rogers: I just want to touch on that question as well around curiosity, because you’ve mentioned that before, when we spoken, and then, and just that insatiable appetite for curiosity, and being curious about subjects and that’s how you best learn, so do you want to tell us a little bit about what you think drove that passion and that curiosity and what’s taken you into this journey of being a leading expert in your profession?
Lucia Saliba: I think my curiosity and passion for learning comes from a very young age and it’s largely influenced by my parents, both of whom didn’t have the opportunity to be educated in their country so when we migrated to this country, they brought that curiosity and passion for learning and gave it to us as well, passed it on to us. We often would have discussions at home about various current affairs and different countries. Dad bought us a, you know, the old encyclopedia sets and I’m sure every family has on their book cupboard. And we used to watch shows like 60 Minutes, where we would discuss world affairs and things like that. We were encouraged to ask questions. We would often write to the encyclopedias to look something up about various countries. And so it was always, you know, in our home. And I think that’s where my curiosity for learning started. At school, I was also lucky enough to be encouraged by very good teachers. So I felt rewarded for having a curiosity for wanting to learn. In medicine, I’ve always aimed to give the best treatment possible to my patients so that would often drive me to want to learn more and to be able to give those good outcomes.
Brendan Rogers: Can you also just tell us, give us a bit of framing around the journey involved in the education behind doing what you do because you don’t just walk into a medical profession after a couple of years. It’s a really long process. Can you give us a bit of background of how that works?
Lucia Saliba: Yeah, it is a long process. And it is one that requires commitment and resilience and being able to stick to something. So it starts with leaving high school, getting into university into medicine. These days, it’s more complicated again, where there are both undergraduate degrees and postgraduate degrees where you might have to do another degree first. Once you’ve finished your six years of undergraduate or four years plus another degree of postgraduate medicine, you can become an intern, which is just about the most fun you can have because you now have a license to be a doctor and you get paid for doing not very much intense work but a lot of work, but you get paid. And that’s the first time, that was good fun. That lasts about a year and then, you become a resident in the hospital system. At that time, you get a feel for what field of medicine you might want to go into.
And that a lot of people will branch off either into the medical fields like cardiology or general medicine or general practice, or in my case, it was into surgery. And there are many different branches of surgery that you can choose from. Once you’ve done a couple of years of residency, then you can apply for a training scheme. The general surgical training scheme is roughly four years long. At the end of that scheme, there is an exit exam that you do. And for most trainees, once they’ve passed their exam, they will go on to do further years of post-fellowship training. And that may be in a subspecialty. So in my case, it was breast surgery and endocrine surgery. And that for me was two years of formal training. And then, a further couple of years of informal training and in some reconstructive surgery, while I started to work as a consultant. So many years is invested in getting to a consultant position.
Brendan Rogers: Wow. As you said, that takes a lot of commitment and dedication. And I imagine there’d be some really good parts of that journey, but probably some tough parts. And often, we talk about that why like, why do we do what we do? Have you got some clarity around that for you? What sort of took you through the real challenges in that journey?
Lucia Saliba: You’re right. At times, it can be very challenging, you know, long hours you’re working, plus you’re trying to study and learn as much as you can along the way. So it can be quite challenging from time to time. You do, you’re right, you have to have a why. For me, it was all about wanting to help people initially, but wanting to be the best doctor I could be to provide the best care. And that was, I’ve always taken responsibility all the way through from even when I was an intern, right the way through all of my training to now being a consultant. So it wasn’t much of a transition for me, but that being able to help somebody at the worst time in their life, for me, it’s about helping them to get through a challenging time, to get back to having a fulfilling and normal life as much as possible. It’s a privilege to be able to help somebody through that and to see them get better. I developed such strong relationships with my patients that I continue to see them for many years. Often, I’m considered part of their family, which is an absolute honour and privilege. I guess all that drives you, but really, being able to help people through a difficult time and feeling that you’ve made a difference is what drives me most of the time.
Brendan Rogers: Luci, I think all of us nowadays unfortunately have been touched by cancer, not necessarily directly, but in our families. When you talk about that term best care, what does that best care scenario look like for you? And how do you deliver on that?
Lucia Saliba: The best care scenario is a multifactorial thing. So, I provide really one part of that care from initial communication, initial diagnosis, explaining and allowing the patient to understand what is happening with them. My personal part is to provide the surgical treatment where necessary. And for me, it’s part of a much more holistic approach in cancer therapy. We work as part of a multidisciplinary team, so there would be an expert providing each part of that treatment. So I would be the expert providing the surgical treatment. There would be another expert providing the medical oncology or chemotherapy or medical treatment. Another expert providing radiation oncology if it’s needed, and further experts providing things like psychology, physiotherapy. We have clinical nurse consultants who also add to that whole multidisciplinary team approach. For me, I see myself as one of the team leaders, because I will continue to see that patient throughout not only their care, but their recovery and then to surveillance moving forward. And for each patient it’s different. It’s different what surgery they require, what treatment they will require. You know, it’s not a cookbook approach. It’s a very much, each person is a different person and needs different things.
Brendan Rogers: You mentioned you’re a team leader. You see yourself as a team leader. Let’s start to talk about that from a teamwork perspective. And what do you see as your responsibilities as that team leader in that best care process?
Lucia Saliba: My responsibility is to firstly coordinate their treatment. So I sort of a broad coordination of giving the patients a timeline, letting them understand what to expect moving forward. With respect to my own area, which is the surgical management, I’m a team leader of my team, which starts in my office. So, I lead my reception staff and they help to provide a smooth transition between all of the different aspects of treatment. In the hospital itself, as a surgeon, you know, I work with a team. I have an anaesthetist and I work with nurses, trainees and we have medical students visit our theatre. We have interns visit our theatre. We have nursing students also there. So, as a team leader, I’m there to make sure that the best outcomes occur by making sure that all of the safety standards are followed. But also, that we have a generally calm, well-functioning theatre, where everybody is attending to their duties, but also doing it in a very calm and professional manner, which adds to the outcome. In terms of the team, I see myself as helping to create that environment. And I’ve learned through mistakes and challenges along the way about how to best approach and create that in the team. I have a learning approach where everybody is allowed to ask questions and learn and give their opinions. That all adds to the final outcome for the patient.
Brendan Rogers: And I definitely want to get into some of those mistakes and challenges. You know, we all love to hear about that sort of stuff, but let’s take a walk into the theatre, so to speak. Can you just give us a little bit of a description around you as that team leader, you’re helping someone on the theatre table and prepping for surgery. What’s that teamwork aspect of yourself and an anaesthetist and the nurses and things in there. What does that look like?
Lucia Saliba: We’re all sort of parts of a process or a machine. We’ve all got our own little bit that we need to do. The anaesthetist is taking care of the patient’s vital signs and breathing and giving them the anaesthetic that they need that allows us to do our surgery. The surgical team helps from the smallest things like positioning the patient to shaving off bits of hair that we don’t need, checking it’s the correct patient, checking we’re doing the correct side. So there’s a lot of checking that goes on before we even put knife to skin. It also involves communicating with our nursing staff, making sure we’ve got all the equipment that we need, that the equipment’s working. All of that is happening kind of simultaneously. So it looks a little bit like organised chaos, but everything is happening for a reason.
At the beginning of my theatre list, I usually stop, have a look at the list of patients that we’re operating on, and we go through them and just make sure that we’ve got everything that we need. And we do that as a team. We call that a timeout. Some people call that a huddle where we’re basically looking just to make sure that we are going to be able to run smoothly during the course of the day. All of that adds to patient safety. So, everybody knows what we’re doing. Everybody knows the rough timeline. We factor in tea breaks and lunch breaks and if there are relieving staff available and that sort of thing. So all of that kind of almost looks like it takes place at the same time. In the surgery itself, I will generally, if I’m teaching, then a registrar may be operating, but I’ll be taking them through step-by-step.
I do have requirements that they have to follow before they are allowed to operate. And that involves displaying that they’ve read up a little bit about the surgery, reviewed their anatomy, and can have a bit of a discussion about what we’re doing. If I’m operating, then the registrars will be asking me questions or I’ll be talking through the steps as I’m doing it. So, it’s a very interactive environment. I also like to keep it calm and pleasant. So, we do have music playing.
Every surgeon is different. Some surgeons like complete quiet. Some surgeons don’t mind a bit of noise. We have a bit of chatter going on and, but our focus is always that patient.
Brendan Rogers: And I have to ask, I want to keep a bit of lightness about this, but is there a favourite song that you’ve got, or the team’s got that you play during surgery?
Luci Saliba: Well, it depends. I’m a little bit moody with my music, but I don’t mind R&B and I like Motown. One of my anaesthetists knows that if I’m getting stressed, he plays a particular song, which lightens it up, which is Eye of the Tiger, which kind of gets me, gives me a giggle and gets me back into focus. And, you know, my music tastes change. We have anything from classical music to AC/DC, depending on what we’re doing. Yeah. So it can vary. But the rest of the team, the nursing staff and the junior staff are allowed to bring their music in as well. And if I don’t like it, I’ll tell them, so. (Laughing)
Brendan Rogers: It’s really interesting to hear how, I guess you lighten up the mood and in a pretty serious situation, that leads me into those challenges that you may be referred to earlier. High pressure environment, and if you can believe what you see on these hospital television shows, you know, there’s stuff that may go wrong during a surgery and there’s extreme pressure happening. So what sort of challenges do you have? What sort of behavioural challenge do you see within the team when those sort of things do happen?
Lucia Saliba: Look, they do happen. Thankfully, they don’t happen too often because the surgeons were often control freaks, so we try and control every aspect. But look, they do happen and people respond to that kind of stress in different ways. You know, I have to say something I’m not particularly proud of in my younger days. I would tend to get quite stressed and with some people quite angry or just not coping with that stress, so over time, I’ve had to learn how to cope with that stress, particularly if you know, it would happen if I thought that nobody was sort of paying attention to me or paying attention to the surgery, so that was in my much younger days. And I think that was all about more to do with my feeling of not being able to control that situation. In time, that is not an issue.
And I have, many surgeons will have almost a routine of how to control a situation if it gets out of hand. So simple things like letting the rest of the room know that there’s something not right and asking the chatter to be stopped. Sometimes, I’ll ask for the music to be turned off so we can all focus. I’ll tell the anaesthetist what’s happened so they can prepare in case it is something serious. And doing simple things like changing the lighting or getting a better retractor or just repositioning things can sometimes be all that it takes to regain control. It’s just about having a way in your mind. It’s like you would do, you know, take 10 breaths before answering. Somebody is upsetting you, we would do, let’s go through this sequence of points that you can do to sort of calm yourself in that stressful situation. But yes, it can get really hairy sometimes particularly if you’re operating in a trauma situation or a difficult cancer situation, you can come across that. But thankfully, that doesn’t happen too much for me these days. So I’ve got a much more controlled surgery. Yeah.
Brendan Rogers: Let me relate this to sport. First of all, you know, I play football. I try and play football, I should say. And you’re talking a 90-minute match, so you sort of gotta be on for 90 minutes. If you relate that to what you do, and these surgeries I imagine go on for hours and hours and hours, how can you stay so focused or how do you and your team stay so focused in order to do the best job you can? ‘Cause let’s face it, it’s a life and death situation.
Lucia Saliba: Look, most surgeries don’t go for too long, but we do have some of the reconstructive ones in particular that can go for quite a few hours, sometimes up to six hours or more, eight hours, even longer, depending on the difficulties of the case. My approach is to break it up into three-hour or four-hour slots. I’m quite mindful of the team and my assistants as well. So, we will often break, meaning leaving the table asleep. Leaving the patient, sorry, asleep on the table, with the anaesthetist or a nurse watching them while we go off and have a toilet break or a drink, or to clear our heads. And then, we will come back to it because it is difficult to keep focused. Also, as I said, you know, before, I try and do things within those lists to make the mood a little bit lighter because that tends to sap energy as well if we’re having too serious at times. So we do play music, we do chat a little bit, we talk about other things, although we’re completely focused on the sort of more routine parts of the surgery, we might crack a joke or have a chat about something, but we have ways of breaking that tension, which can help with focus as well. I’m mindful of the other team players as well. So, you know, all the team are encouraged to tell me if they’re tired or they need a break or whatever. So we have that ability to stop at any time.
Brendan Rogers: Luci, do you always get to pick your team? The full surgery team that’s in there with you?
Lucia Saliba: No. (Laughing) No. It’s very rare in the public system that you get to pick your team. Sometimes, particularly, the older surgeons have been around a long time. They may be able to have a particular scrub sister that is always with them, or, but for most of us no, we have to be able to adapt to having different team members each time, for example, with our trainee registrars who are our assistants, and who, we also teach, we have a different one every six months or so. So, we only have them with us for six months. During that time, they learn what they can from us. And then, they move on to another rotation. In terms of nursing staff, we have different nurses and you will have people of different levels of experience as well. So, it can be, sometimes it can get quite frustrating, like it would in any job. If you’re having a bad day, things are not going as smoothly as you’d like. And you’re having to sort of relate to people you’ve not either worked with before, who don’t know you, and you have to have ways of managing that.
Brendan Rogers: Can you maybe talk to that a little bit because why this is so fascinating to me is that, you know, we talk so much about trust in teams and that is just such a foundation of high-performing teams. And you guys have to be high-performing, but you’re just saying that you don’t always get to pick your team. So, how do you develop that level of trust? How does that just come together to be this team that does such a great job for the patient?
Lucia Saliba: Look, I think we’re dealing with a bunch of professionals first of all, and the trust comes from firstly respecting their expertise and where they’re at. Trust also comes from knowing where that other person is at in terms of experience. So, if I know I’ve got a nurse working with me who’s fairly newbie and is new then I know that I’m going to have to approach that operation a little bit differently, where I’m going to have to spell things out and be specific in what I want. Whereas, if I have a nurse who’s more experienced, then she may be able to follow the operation without much instruction and help us along the way, giving us the instruments that we need and things like that. Obviously, if you’ve got a team that you’ve worked with before, trust is a given, but I think trust can be formed fairly quickly, firstly, by you as a team leader, showing that you’re trustworthy, that you’re capable, that they can trust you in this situation. And very often, I find that the rest of the team will give you their best and you’ll be able to trust them as the day goes on if it’s in a very new team. Obviously, you will get people that are not team players or are not good in that particular situation. And you just have to learn to work around them. And what I find there is the other team members tend to take up the slack.
Brendan Rogers: What does a, can I say, a non-team player look like in your environment?
Lucia Saliba: Yeah, there’s a few of them. (Laughing) Look, I think it’s usually the person who either is not interested, not prepared, not wanting to be there. And they’re pretty obvious, you know, they will stick out in most surgical teams in the theatre because most of the time, people are not like that. Often, those people will often have earned themselves a little bit of a reputation so you know what you’re getting on the day. And in the past, they’ve been a challenge for me to work with where we’ve had clashes of personalities or not communicating properly, not understanding each other. So in such an intense team, like a surgical team, they will stand out quite obviously, but often, yes, their knowledge is often missing or their attitude is not good. They tend not to last too long in their operating theatres, those kinds of people. They will find a place for themselves somewhere else.
Brendan Rogers: I have to say, it’s a little bit scary to think again that the sort of work that you and your colleagues are doing that there’s people that may have that sort of mentality. But I guess at the end of the day, it’s a profession, it’s a job for some, so it doesn’t necessarily mean it’s different to other jobs.
Lucia Saliba: No. It’s very similar to other jobs, except I think where, you know, I’ve been lucky in that the vast majority of people I’ve worked with have been very professional and committed. And as I said, the ones that don’t want to be there, that it’s not their world. And it is a very, as I said, a very intense, stressful environment that for some people, they cannot cope in that environment and they will move on, and we have that across the range of jobs. So they could be nursing staff that we’ve had, registrars or trainees who have decided it’s not for them. Surgery, for some people, sounds like a great idea until they get into that team. And then, it’s not such a good idea.
Brendan Rogers: You are a leader in your field. Off the back of this teamwork stuff that we’ve just extensively spoken about, when you are leading a team where that non-ideal team player is about, how have you learned to manage that as a leader in your own development?
Lucia Saliba: If it’s a trainee where I feel directly responsible for them, then I do try and identify what the issues are with them, and try and work through the issues with them. And most cases that I’ve come across, it hasn’t been a lasting issue. And that person has usually improved. Where it’s been a person where there’ve been a lot of problems, where their attitude or skills are not or knowledge are not up to the standard that we would expect, and they’re not willing to improve or change, I have had difficulty in that situation. And often, I will either call on my senior colleagues for some help in sorting them out or finding ways to manage them in that situation for the time that we have them so that they get to some sort of direction. And in very rare cases where I’ve really had issues, I’ve had to separate myself in that situation.
But it can be quite challenging. You know, I’ve had trainees who have come with a pre-existing reputation. I find that with a bit of guidance, they’re excellent and go on to become very good doctors. And there are some that timing might not be right for them and some where it’s not the right specialty for them, or yeah, so we do have challenging issues. And again, we approach that as a team as well. So, in whatever hospital I’ve been, it never comes down to one person to manage performance issues. It becomes a team issue. We have directors of training. We have term supervisors, we have a sort of multi-pronged approach to these kinds of challenges.
Brendan Rogers: We said in the introduction how you also spend a lot of time in the training side of thing with registrars and things. Now, you’re training the next generation. What’s that looking like for us? You know, you hear a lot of things in all sorts of industries about this next generation and what they’re like and all that sort of stuff. And, you know, we don’t want to tarnish everyone with the same brush, but what are the challenges you’re seeing for the next generation coming through, given that you’re a coach, you’re a leader in training these people?
Lucia Saliba: Look, I think their training is a little bit different to the training that we went through. There’s been emphasis more on their well-being and things like safe work hours have been brought in. Our college, the college of surgeons is very proactive in terms of managing issues such as bullying and harassment and that’s created, although, a better working environment in general. It has created some challenges in terms of training. And it has meant that for many of us, me include having to adjust or change the way that we might train people or in particular speak to them or guide them or criticise them so as not to be seen as sort of bullying in any way. So we’ve become more mindful of that. I certainly have had to do that. I’m pretty much a straight talker. And for some trainees, that may be perceived as being inappropriate or pushy or bullying or whatever. So I think that has had an impact on how they are trained. For most registrars though, I’m pleased to say that they want to learn. They’re hardworking. They put in a lot of effort and are responsible for their learning. And they take that on board. We do have some that are challenged and have problems, and they’re usually counselled, but for some of my colleagues, engaging in teaching has become so much of a challenge that some of them have given up teaching or given up positions in public hospitals or things like that. So we all have had to change. But I think, in terms of the public’s perception, I think that the future of medicine is safe. It’s just that we’ve had to learn to do things in a different way.
Brendan Rogers: Yeah. And I imagine it would be a very, very fine line again, given the pressure situations you’re in and those behaviours under pressure that sometimes, you just need to say something and it may not always come out or seem to come out in the right way, but there’s context behind that. That would be a very fine line into how people can perceive things. And particularly, again, going back to that point where you don’t get to choose your team, so people don’t really know each other. So there’s that, not that really high level of vulnerability-based trust that we talk about. There’s a level of technical-based trust because you’re all professionals and stuff. That must be quite a fine line to walk.
Lucia Saliba: Yes, that is, it is a fine line. And I guess it comes down to perception at the end of the day. And your intention may be one thing, but the way your actions or your words are perceived can be another thing definitely that can lead to misunderstandings, complaints, loss of satisfaction in the workplace and all sorts of things. So that perception is really, really important. And sometimes, you can’t do anything about it. And as you say, when we’re in a pressure situation where there is an emergency happening, or there is an issue, and you’re focused on the job at hand, which may be a life-threatening situation, you sometimes forget about the niceties of being polite or things like that. That can get impacted. Most people you would hope though, would be able to understand the context of what’s happening at that point in time and appreciate the seriousness and not take anything personally. And certainly, the good trainees that are there to learn will understand the situation and see how they can help and what they can learn from it.
Brendan Rogers: Luci, with the registrars, those coming through that you’re coaching and training, are there any red flags that you see in your own experience where you think, “Oh, this person maybe needs some, lots of guidance” or maybe, “This is just not for them”. What are those red flags that you see?
Lucia Saliba: Yeah, look, most of the red flags have to do with attitude. So how they interact, not only with myself, but how they interact with nursing staff in particular. So we have had situations where some registrars have behaved poorly towards nursing staff or to myself. We hear about all of these. So I do, where possible, take those registrars aside and have a chat to them about more appropriate ways of behaving. Patients will report on the registrars as well when they come and see me after their surgeries and tell me what their experience was like in the hospital. And they will give me a report on my team very often. Other red flags are to do with either poor organisation or not preparing for cases and surgery. So those things often can be managed fairly easily by helping somebody to organise their time or organise their study so they can get more out of the whole interaction with the patients and in theatre, and so that the learning experience is better for them. Most registrars, when spoken to or guided, will take that advice on board and will improve thankfully. Some will not though and need sort of further guidance, which is, you know, we tend to give that more as a team effort. So that team thing comes into play again, where other surgeons in the team will also be involved.
Brendan Rogers: As a team, again, you’ve talked a lot about the team and your broader team, and you’re leading that. How often do you debrief situations? So, whether it be surgery or whether it’s a patient’s needs, whoever, what does that look like in your industry?
Lucia Saliba: So look the debrief process can happen in a number of situations. So the first one would be where something clearly goes wrong, where there’s been an injury to a patient or a complication. In that situation, we often will, once the patient is treated and out of danger, we will usually start that debrief process almost immediately as the case finishes, certainly with my registrars when that’s occurred. The purpose of that is for us to talk through what’s gone on, see if there’s any preventable factors, work out how to do things better next time, but also so that everyone involved can feel that the burden of that case is borne by everyone. I don’t know how to explain that better so that no one person would feel responsible in that situation for anything that’s happened. We all, as a team, would work together and take that all on board.
So we all improve. I never want a trainee of mine to leave the theatre feeling like, you know, it’s all their fault or something has happened because it’s their fault because that’s not constructive. And you’re not likely to learn in that situation if you’re feeling hopeless or guilty or whatever. So I try not to play a blame game. It’s just what’s happened. And we all kind of will learn from it. Most registrars will find that very helpful. And I’ve been lucky in that most of my registrars, with the exception of maybe one, most of them have taken responsibility for what’s gone on if they’ve been involved and they’ve taken that patient on as their own. So they’ve become more involved in that patient’s care, following them up more closely talking to the patient, providing open disclosure, telling them what’s happened. So we find that debriefing process can help a lot for that registrar to work through what’s happened. We have other debriefing situations, where every month or two, we discuss all of the cases that have gone through a unit. And we discuss the cases where there have been complications or problems so that all the surgical team, meaning all of the surgeons, all of the trainees get to learn from each case, which I find very useful because it’s not necessary for us to make every mistake to learn from it. We can learn from others as well. So yeah, debriefing is very important.
Brendan Rogers: Off the back of that question, I want to move us into this culture in medicine, in the environment you work in, because, you know, that culture of no blame and debriefing is really important. But in organisational environments, I guess we call it office politics, is there such a thing as hospital politics?
Lucia Saliba: Oh, there is. There’s politics in everything.
Brendan Rogers: What does that look like?
Lucia Saliba: (Laughing) In medicine, it can be quite complex. It can be quite simple. I’m not a good one to be playing politics. And anybody who knows me will laugh when they hear me say that because they know I’m not good at it, but it’s about sometimes playing the game, learning to get on with people. However, it can be good in pushing forward the needs of a particular unit or surgical team. It can also be seen in some lights to be not so good in terms of where it can obstruct the progress of a team or a particular surgeon. I have seen professional jealousies occur, people controlling situations to suit their own needs or their own skill set. So there is hospital politics, but thankfully, for mostly, these days it’s not so prevalent, but you know, like any corporate structure, you will see politics. And unfortunately, we do. We all have to learn to play these political games to get on in the workplace. As I said, I’m not so good at it because I tend to say what I think, so (laughing).
Brendan Rogers: Does that get you in trouble sometimes?
Lucia Saliba: Oh yeah. Quite often. (Laughing) Quite often. It’s been one of the learning things in my life I think is to not always blurt out what I think. Or to find a softer way sometimes of saying something, so…
Brendan Rogers: That’s a really good point in that, I guess your own self-development and self-awareness, what have you done to bring yourself to become more aware of that so that you just, it’s not that you hold back on what you need to say, but you just maybe check yourself to say it in a different way that people are going to hear it in the way that you want them to hear it.
Lucia Saliba: Yeah, correct. And look, a lot of it comes from having made lots and lots of mistakes in my life in terms of communication. I have a fiery temper and having to learn to control what comes out of my mouth sometimes has been a good learning process for me to be honest, but I am very passionate about what I do and I’m passionate about patient care. And sometimes, if I see something not being done correctly or not being done to a correct standard, then, I might say something quite strong about that. These days, I still have the same passion for patient care. And my only priority has always been, it remains patient care. But I have learned to just step back and take a few deep breaths and possibly reword what I’m about to say into a nicer, more gentle way. If I feel I can’t do it, then I wait.
I’ll actually collect my thoughts a little bit better and then approach that person or that situation a little bit later. That way, I find I’m not letting off a bomb in the middle of the room and having all this collateral damage that can sometimes happen when you just let yourself go unchecked. But I find this sort of more temperate controlled approach does seem to resolve an issue a little bit more satisfactorily than what my old approach would do. So, yeah, I think it’s just about, I’ve had to reflect a lot on that kind of behaviour and although it comes from a good place and my intention is good, I have had to remind myself that I am dealing with other professionals and other people and they may not see my intention. They might just see my display of anger and therefore, the message is lost.
Brendan Rogers: I’m not setting you up with this question, but in that self-awareness piece, it just fascinates me because we’re all a bit the same. We’ve got many weaknesses. I understand that I’ve got more than enough, just ask my wife. But in an environment that you’re in, and again, those behaviours under pressure, I imagine that that awareness falters from time to time.
Lucia Saliba: For sure, it does. We are human. I can be the queen of the one-liner and I can, I’m very quick to answer, but, I think, maybe because I’m a bit older, I think, and I tend to choose my, I think I decide at the time, whether it’s a fight I need to have, or whether it’s something that needs to be said at that point in time, I think what I’ve realised is sometimes, just going off and just saying something or losing my temper, it’s not going to make the situation any better. It’s going to add to more stress and more anxiety and within that situation. So it’s also a realisation that possibly that behaviour did not have the outcome that I wanted and didn’t improve the situation. So learning that that would not work. Sure. There are times when, you know, the F bomb goes or something else because it is required. But thankfully, that’s rare.
Brendan Rogers: Thank you for sharing with me. I’m going to stop that subject now. I’m going to take you off the hook.
Lucia Saliba: (Laughing) You’re getting me into trouble.
Brendan Rogers: Absolutely. Absolutely. I’m not trying to. I want to just ask you around, you’ve mentioned that focus on the best patient care a number of times. You could have done that in a multitude of spheres across the medical space. What is it about the breast cancer side of the thing that drove you into that area of passion?
Lucia Saliba: Initially, I think I wanted to do, I thought back in my, when I was an intern that I wanted to do plastic surgery because I have a creative side and I thought that that would be pretty cool. Everybody wanted to do that. And as time went on in my training, I got to do a breast surgery term and I was lucky to work with some of the most eminent surgeons in that field. And I developed a passion, I think at that time for actually helping patients with breast cancer. What I find is that I have a, obviously a natural ability to communicate with other women, being a woman myself. I can understand the impact that having breast cancer can have on a woman’s emotional well-being. So that drew me to that.
The other thing about breast surgery is particularly with the reconstructive surgery that I’ve learned over the time. It’s allowed me to work in that creative field as well, where I can reconstruct or help to produce a cosmetically more appropriate or beautiful breast for a patient with breast cancer. My aim at the end is that I leave as little impact on their life as possible in terms of physical deformity. You know, I don’t want them to look in the mirror every day and think, “Oh my gosh, I’m a cancer survivor”. You know, I’d want them to look in the mirror every day and say, “Oh, I’ve beaten this. And I’m going to get on with my life as normal.” So the cancer side became more of a passion and then, but that creative drive didn’t go away. And I actually considered going back and doing plastic surgery training. However, later in my training and in my fellowship, I discovered that they were doing things quite differently overseas, where a single surgeon or single team could approach both the cancer side of it, as well as the reconstructive side in the same team or same doctor could address both issues. And that really appealed to me. And that’s when I started in this world of oncoplastic surgery that involved getting further training mainly overseas as there wasn’t any training at the time here in Australia. However, I’m very happy to report that in Australia, we have an excellent training program now for breast oncoplastic surgery for the current trainees going through and that’s through our college. So that’s been very good to watch develop over time. But for me, it’s very rewarding to see somebody go through this and then come out the other end, healthy and happy and getting on with their life.
Brendan Rogers: With the work you do, I normally ask people, what sort of advice would you give leaders around this and that, whatever. I want to ask you, what sort of impact are you wanting to have on the world with the work that you do?
Lucia Saliba: Look, I think, firstly, I’d like to improve the lives of people who have to go through this disease and at least give them back or help to give back their sense of self as well as a sense of wellness so that they can go back into life and contribute to life and to their family and to the community as best they can in any way that they want to. In terms of teaching, I’d like to have an impact there. I’d like people to learn. My trainees to learn from my mistakes so they don’t make them themselves. I’d like to give them a belief that this is a great profession, that this is something that you can be proud of, that you can contribute to the world and you can contribute to other people’s lives. Also, I think, for my registrars, I’d like them to know that the learning doesn’t stop, that our training, our surgical fellowship is really just a license to keep learning and to keep growing and to keep helping people. So I hope that they would pick that up as well, that the learning part of it never actually ends.
Brendan Rogers: Luci, with that, I know you’re a very, very busy lady. I know you’ve got surgery again in the morning and stuff. So thanks for giving up your time tonight. How can we get hold of you if somebody wanted to just drop you a line and just say, “Thank you very much for sharing”?
Lucia Saliba: Oh, look. They could pop on to, I think we have a website (Laughing). I’m technically terrible. (Laughing) I think we do. You can contact us there. And at our website, you can call our rooms, which is the numbers on the website. But yeah. Happy to hear from anybody.
Brendan Rogers: I can confirm you do have a website.
Brendan Rogers: (Laughing) Absolute pleasure. I definitely need to know if my guests have got a website.
Lucia Saliba: (Laughing) I’m terrified of computers most of the time. So, yeah. I have a great team that looks after that.
Brendan Rogers: Absolutely. Well, look, Luci. You can’t be great at everything. So look, what I want to, I just want to say thank you very much for giving up your time. Fantastic. Really massive congratulations on the work you’re doing. It’s been a pleasure talking to you and thanks for being a guest on The Culture of Things podcast.
Lucia Saliba: Thanks, Brendan. Thank you.
Brendan Rogers: As I said at the start of the show, October is Breast Cancer Awareness Month. It was such a privilege to speak with Luci who is one of the leading breast cancer surgeons in Australia. A big shout out to my good friend, Andrew Paton-Smith from Jazoodle, who helped arrange this opportunity. I think you will agree, Luci is amazing. Her humility, passion, and self-awareness shone through in the conversation. Her commitment to patient care is of the utmost importance to her. And the impact she is having is enormous. Every day, she is improving the lives of people who have to go through breast cancer. She’s giving people a sense of self and a sense of remaining a valuable member of the community.
Luci is training the next generation of surgeons, helping them to learn from her mistakes, and giving them a purpose and belief that they are contributing to society. She’s also teaching the next generation that the learning never stops. Luci is demonstrating true leadership every single day.
These were my three key takeaways from my conversation with Luci.
My first key takeaway. Leaders have a relentless drive for improvement. Luci said it herself. She wants to be the best doctor so she can provide the best care. To do this, you have to always be curious and keen to learn. It also wasn’t just about her own improvement. She has in place specific debriefs, allowing the team to learn and improve together. This drive for improvement helps ensure the best care for patients.
My second key takeaway. Leaders show humility. This virtue was evident in Luci throughout the conversation. Most people know humility as not being egotistical and braggy. The less common understanding of humility is that you also understand your own strengths and weaknesses. You know what you’re good at and what you aren’t.
Luci shared on several occasions her strengths and was also humble enough to share her weaknesses. Humility in leaders is a key foundational virtue. Humble leaders thrive leading teams and may thrive being in teams.
My third key takeaway. High-performing teams contain individuals who are clear on their role and responsibilities. Luci said it best when she stated, “We are all part of a process. In the surgery team, every single team member knows their role and what they are responsible for. And everyone else on the team knows what each other person’s role and responsibilities are.” This provides clear lines of accountability, which always leads to better results.
So, in summary, my three key takeaways were: leaders have a relentless drive for improvement, leaders show humility, high-performing teams contain individuals who are clear on their role and responsibilities.
Dr Saliba was recently interviewed by Brendan Rogers on his hugely popular “The Culture of Things” podcast. This is the first time that Dr Saliba has been a podcast guest and she shares her journey in medicine, her calling at a young age and even which type of music she likes listening too whilst operating in theatre! Catch the episode here
Who is injecting fillers into you? Why you should be very wary
We are proud of the appearance treatments that we provide. We are also proud of our luxurious clinic facilities. Even more proud though, are the safety and back up of the medical facilities and skills available within the clinic. This is particularly important when it comes to invasive procedures, such as lip and dermal fillers, facial sculpting and PRP. Do you know who is injecting fillers into you?
We’ve all seen the headlines recently in the ABC and other news outlets. Calls for greater regulation in administering cosmetic injections, along with the need to improve facilities. The team at Le Sands Clinic are wholly supportive of tighter regulations, and we’ll detail why below. When it comes to injectables, be aware, not all practitioners or establishments are equal.
The scourge of cheap treatments
In many respects, the use of cosmetic injectables has, and rightly so, become more mainstream recently. At Le Sands Clinic, we provide a number of enhancing and sculpting procedures along with PRP treatments for our clients. Dr Saliba, is a senior consultant breast surgeon, and highly qualified injection practitioner. Think about this, we’ve been fed a diet of thinking that injections should be cheap. We strongly advise that whoever you use, do your research and that price should not be your only consideration.
With many potential pitfalls, an in depth knowledge of facial anatomy is essential in order to reduce the risk of adverse effects or outcomes, some of which could be life changing, such as blindness. One question to ask your practitioner is – how familiar are you with facial anatomy? Behind your skin are a myriad of blood vessels, muscles, bone and other structures. Your practitioner should understand and visualise these before any injection. Recently, a lady suffered enlarged lips and considerable swelling, due to the practitioner injecting filler into an blood vessel. A potential lethal mistake. I believe that:
” it is imperative that whoever is injecting you intimately understand facial anatomy. They understand and can visualise, where each of your vital organs, vessels and structures are before starting treatment. They should understand balance and symmetry in the face. The effect of treating one area on how that influences shape and symmetry of other areas of the face.”
When wanting the cheapest treatment, think about the words above. Think about the skills and qualifications you should be insisting upon – you want the best. The best is not the cheapest.
Another aspect of safety, is the level of medical equipment and skills available should something go wrong. This is rare, however, reactions can occur. The body can disagree with the substance, and let’s face it, serious, unconnected medical episodes can occur at any time. Does your establishment have defibrillation equipment on hand? Or qualified medical doctors on site at the time you are having your injections? Many businesses do not. They rely on a Skype or other system of doctor consultations. Skype is not going to help you should you run into difficulties in the clinic
Also, what other equipment is available in your clinic? At Le Sands Clinic, we have a range of life monitoring equipment. Our staff are trained in CPR and First Aid. We also only ever have myself, (Dr Saliba) perform any invasive procedures. I must repeat, medical episodes are extremely rare. However, because they can happen, we feel all injectable clinics should be suitably skilled and properly equipped.
We believe anyone wanting fillers or sculpting should be very careful who they have perform these treatments. The ability to provide artistry to the process, the safety equipment on site is paramount. Also important is having a medical doctor on site, with the right equipment available should something go wrong. Having filler injections can provide so many benefits to our clients, but is not without risk. Why would you go for cheap, when you should really be going for the best and safest.
Dr Lucia Saliba is the founder and CEO of Le Sands Clinic in Brighton Le Sands, NSW. She is a senior consultant breast and general surgeon. A graduate of UNSW medical school, and Master of Surgery (Breast Cancer) bestowed on her from University of Sydney